Abstract: Objective: To summarize the direct and indirect imaging signs of patients with spontaneous cerebrospinal fluid rhinorrhea, so as to provide basis for the imaging localization diagnosis of leakage points before cerebrospinal fluid rhinorrhea repair. Methods: The clinical data of 48 patients diagnosed and treated in the Department of Otorhinolaryngology, Xiangya Hospital, Central South University from January 2017 to March 2021 were analyzed retrospectively. All patients underwent HRCT and MRI of nasal sinus and skull base before operation. The direct and indirect imaging signs were analyzed before operation, and the location of the leakage point was confirmed in combination with the intraoperative situation. Results: The leak points of 48 patients were determined by imaging and confirmed by operation. The leak points were located in cribriform plate in 20 cases (41.7%), lateral recess of sphenoid sinus in 16 cases (33.3%), the ethmoid roof in 8 cases (16.6%), posterior wall of frontal sinus in 2 cases (4.2%) and clivus of skull basein 2 cases (4.2%). The study found that the direct signs and indirect signs of spontaneous cerebrospinal fluid rhinorrhea in different regions were significantly different. Indirect signs such as left-right asymmetry, drainage channel edema, sinus mucosal thickening and effusion signs could be used to find the leak point. The diagnostic coincidence rate of the leak according to the direct signs of skull base bone defect in imaging was 66.7%, while the combination of CT and MRI was used to image the leakage points according to the combination of direct signs and indirect signs, the diagnostic coincidence rate was 100%. Conclusion: The indirect imaging signs of patients with spontaneous cerebrospinal fluid rhinorrhea are of great value for accurately judging the leakage point before operation.